The Downsides of Corticosteroid Injections for Knee Osteoarthritis

The Downsides of Corticosteroid Injections for Knee Osteoarthritis

Corticosteroid injections are widely used to relieve knee osteoarthritis (OA) pain, but emerging research highlights significant drawbacks. While they may provide temporary symptom relief, they can accelerate joint deterioration, increase the risk of knee replacement surgery, and lead to harmful side effects. Understanding the downsides of corticosteroid injections for knee osteoarthritis is crucial when considering treatment options.

How Corticosteroid Injections Affect Knee Osteoarthritis

1. Accelerated Cartilage Loss

Studies have shown that corticosteroid injections may contribute to the breakdown of cartilage, leading to increased joint space narrowing. This accelerates the progression of osteoarthritis rather than slowing it down (Kompel et al., 2019). This is one of the key downsides of corticosteroid injections for knee osteoarthritis.

2. Increased Risk of Subchondral Insufficiency Fractures & Osteonecrosis

Corticosteroids can weaken the underlying bone, increasing the risk of stress fractures and worsening pre-existing osteonecrosis, both of which compromise joint stability (Guermazi et al., 2020). This further highlights the downsides of corticosteroid injections for knee osteoarthritis.

3. Potential for Rapid Joint Destruction

Some patients experience severe joint deterioration following repeated corticosteroid injections, leading to increased bone loss and irreversible damage in a short period (Guermazi et al., 2020). This risk underscores the downsides of corticosteroid injections for knee osteoarthritis.

4. Higher Likelihood of Knee Replacement Surgery

Research suggests that patients who receive corticosteroid injections are more likely to require total knee arthroplasty (knee replacement), making them a less favorable long-term treatment option (Wijn et al., 2020). This is a critical factor in assessing the downsides of corticosteroid injections for knee osteoarthritis.

5. Local and Systemic Side Effects

• Local effects: Post-injection flare, skin thinning, hypopigmentation, tendon rupture, and an increased risk of infection (Kamel et al., 2024).

• Systemic effects: Adrenal suppression, high blood pressure, facial flushing, elevated blood sugar levels, and osteoporosis (Kamel et al., 2024). These adverse effects contribute to the downsides of corticosteroid injections for knee osteoarthritis.

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Are There Safer Alternatives?

Given the risks associated with corticosteroid injections, alternative treatments such as platelet-rich plasma (PRP) therapy and hyaluronic acid (HA) injections are gaining attention. Research indicates that these regenerative treatments offer longer-lasting relief while promoting joint health and reducing inflammation with fewer side effects. PRP has been particularly effective in improving function and reducing pain compared to corticosteroids at follow-ups beyond six months (Jawanda et al., 2024; McLarnon & Heron, 2021).

Conclusion

While corticosteroid injections may provide short-term relief, their potential for accelerating joint deterioration and increasing the likelihood of knee replacement surgery makes them a less favorable option for managing knee osteoarthritis. Patients should consider safer and more effective alternatives, such as PRP and HA injections, for long-term joint health. Understanding the downsides of corticosteroid injections for knee osteoarthritis is essential for making informed treatment decisions.

References

1. Kompel AJ, Roemer FW, Murakami AM, et al. "Intra-Articular Corticosteroid Injections in the Hip and Knee: Perhaps Not as Safe as We Thought?" Radiology. 2019;293(3):656-663. doi:10.1148/radiol.2019190341.

2. Wijn SRW, Rovers MM, van Tienen TG, Hannink G. "Intra-Articular Corticosteroid Injections Increase the Risk of Requiring Knee Arthroplasty." The Bone & Joint Journal. 2020;102-B(5):586-592. doi:10.1302/0301-620X.102B5.BJJ-2019-1376.R1.

3. Guermazi A, Neogi T, Katz JN, et al. "Intra-Articular Corticosteroid Injections for the Treatment of Hip and Knee Osteoarthritis-Related Pain: Considerations and Controversies With a Focus on Imaging-Radiology Scientific Expert Panel." Radiology. 2020;297(3):503-512. doi:10.1148/radiol.2020200771.

4. Kamel SI, Rosas HG, Gorbachova T. "Local and Systemic Side Effects of Corticosteroid Injections for Musculoskeletal Indications." AJR. American Journal of Roentgenology. 2024;222(3):e2330458. doi:10.2214/AJR.23.30458.

5. Jawanda H, Khan ZA, Warrier AA, et al. "Platelet-Rich Plasma, Bone Marrow Aspirate Concentrate, and Hyaluronic Acid Injections Outperform Corticosteroids in Pain and Function Scores at a Minimum of 6 Months as Intra-Articular Injections for Knee Osteoarthritis: A Systematic Review and Network Meta-Analysis." Arthroscopy. 2024;40(5):1623-1636.e1. doi:10.1016/j.arthro.2024.01.037.

6. McLarnon M, Heron N. "Intra-Articular Platelet-Rich Plasma Injections Versus Intra-Articular Corticosteroid Injections for Symptomatic Management of Knee Osteoarthritis: Systematic Review and Meta-Analysis." BMC Musculoskeletal Disorders. 2021;22(1):550. doi:10.1186/s12891-021-04308-3.